NASM PES Chapter 13: Injury Prevention for the Athlete

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Chapter Goals:

• Find the strategies for preventing injuries. 
• Find the injuries that are common and related to physical activity.
• Analyze the mechanisms for injury in each body segment.
• Find the common risk factors that will lead to injuries of the body segments. 

Introduction

Specific injuries create a great challenge for athletes and training professionals. 

Athletes in sports are required to do a lot of cutting and jumping, and these activities are quite affected by injuries in the body.

Working at such high performance levels will require the body to work optimally. 

Pre-Activity Warm-up for Injury Prevention

This aims to optimize our performance, prevent any injuries, and arouse psychological acuity. 

The physiological outcomes of the warmup will be increases of: 

• Peripheral blood circulation
• Elasticity in the soft tissues
• Lubrication of the synovial joints
• Oxygen uptake kinetics
• Adenosine triphosphate turnover
• Muscle cross bridge cycling rate
• Muscle fiber velocities of conduction

..and decreases in:

• The viscosity of the inter membranous lubricants
• Cardiac trauma from sudden and strenuous levels of exercise

Active Warm Ups

Active warm ups are any Submax activity where there is an increase in the body’s internal temperature by one degree Celsius. 

The warm up should not cause any fatigue that could impair the performance and lead to injuries. 

The transition phase will be the time between the end of the warm up and the start of the workout activity. 

The ideal warm up will last 5 – 10 minutes and lead into the activity without cooling down the body too much. 

Warm Up Protocols 

Warm up strategies should include these things:

• Submax activities and those that do not fatigue the athlete
• Stretching of some form
• Movements specific to the sport
• Techniques for preventing injuries
• Gradual progressions in the level of intensity and the specificity of movement
• Increases in speed from a half tempo to game pace by the end of the warm up

Epidemiology of Foot Injury

Achilles tendonitis

This is inflammation of this tendon, and it is a common sports related injury. It is often caused by running or jumping or the mechanics relating to those activities.

Plantar Fasciitis

The plantar fascia is a thick and fibrous band and when this injury occurs, it is inflamed and irritated and can be quite painful.  We typically see this occur from overuse of the feet. 

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Metatarsal Stress Fractures

This will be seen as stress fractures of the bones in the feet, specifically the metatarsals. The foot takes the entirety of our weight, and overuse and repeated loading in poor ways can cause stress fractures to occur here. 

Foot Injury Prevention

Some of the common foot injuries can be avoided by rehab and prevention programs. 

We should ensure that we stretch through the whole range of motion.

Stretching should be pain free, done several times a day, and is most effective once the entire body is warm.

Epidemiology of Ankle Sprain

Ankle sprains are one of the most common sports injuries and are number one for time lost. 

Injuries are quite common in all sports, and lateral ankle sprains are the most common of them all. 

Lateral Ankle Sprains

When this sprain occurs, any of the lateral ligaments may become injured. It is the most common, and we also have a high risk of avulsion fracture if the force is high enough. 

Typically, these injuries are from forced plantar flexion and inversion when you are landing on something unstable or uneven. 

Studies show that once you’ve had an ankle sprain, you become 5 times more likely to get it again. This is the real reason for the often occurrences. 

Medial Ankle Sprains

These will involve the ligament of the deltoid in the ankle and may have some avulsion fracture of other bones in the foot.

This one happens when there is a forceful and rapid version of the foot, and it is not as common as the lateral type of sprain. 

Syndesmotic Sprains

These are the higher ankle sprains and involve the distal tibiofibular joint close to the ankle. 

The injury seems to happen when there is some external foot rotation, talar eversion of the ankle mortise, and excessive dorsiflexion.

This injury is seen in sports, most often when planting and cutting or using rigid shoes that don’t allow for sufficient movement. 

Prevention and Rehab Programs

Sprain prevention and rehab are effective for decreasing the incidences of these injuries in physically active people and working to improve the function of the ankle. 

Epidemiology of Knee Injuries

Knee injuries comprise 50% of all injuries in college sports and high school activities. 

The two most common problems we see here are going to be patellofemoral pain and ACL sprains.

The overall incidence of these knee injuries is the same across genders. Still, in sports where both men and women compete, we see women with a greater injury rate due to some knee mechanic differences. 

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Patellofemoral Syndrome

This occurs when there is less than normal tracking of the patella in the trochlea it belongs to. 

The stress on the cartilage increases significantly when there are differences like this.

A larger q-angle can be one of the reasons we see these problems. 

ACL injuries

These will overwhelmingly come from non-contact injuries and when the body is trying to decelerate or change directions rapidly. 

Much of the force from the body’s weight must pass through the kinetic chain, with the knee taking much of this due to being lower in the kinetic chain. 

Patellofemoral Pain and ACL Injury Prevention

Lowering these injuries should focus on strengthening our hip and the surrounding knee musculature since it can be from force passing through these parts of the kinetic chain. 

A lot of programs will make use of balance training and plyometric agility style training.

Epidemiology of Low Back Injury

Around 6 – 15% of athletes will have low back pain throughout the year. 

This creates concern about the need for decreases in training, conditioning, and performance levels due to these problems.

Disc Injury

Injuries to the vertebral discs will happen when the outer fibrous structures of the disc fail and allow the internal contents of the disc to be extruded and irritate the nerves that are exiting the spinal cord. 

Muscle Strain/Ligament Sprain

The ligaments surrounding the spine may fail with the technique, dysfunctional posture, or instabilities of the musculature surrounding them. 

This will decrease our ability to stabilize in various ways. 

Sacroiliac Joint Dysfunction

This joint will take on a lot of force that we transfer from the upper body to the trunk and the legs, so it is subject to many injury chances. 

When stability is not maintained, we end up with more injuries. 

Low Back Injury Prevention

Exercise is important for treating and preventing non-specific lower back pain. Specifically, we see the incidence of low back injuries going down when we strengthen and target the ab muscles, lower limbs, and the lumbar spine. 

Epidemiology of Shoulder Pain

Shoulder pain is quite highly reported; somewhere around 21% of the general population is exposed to it and 40% have it last more than one year at a time. 

The most common diagnosis is for shoulder impingement, which represents 40 – 65% of all reported pain in the shoulder. 

Rotator cuff problems and sports injuries for athletes are big issues in the general population.

We can actually break down shoulder injuries into those that occur to the rotator cuff or those that affect the structure of the shoulder. 

Shoulder Impingement 

Impingement is a more common diagnosis and a compression of the structure underlying the coracoacromial arch. 

The structures in question will be the supraspinatus and the infraspinatus tendons, the subacromial bursa, and the long head of the biceps tendon. 

Shoulder Instability

This is more often going to show up as anterior or multidirectional. It usually occurs due to traumatic injuries associated with improper mechanics and poor conditioning. 

An acute injury will be the most commonly seen reason. 

Shoulder Injury Prevention Strategies

Soft tissue mobilization and self-myofascial release techniques have been proven to increase flexibility and the ability to extend the overactive muscles. 

Both static and neuromuscular stretching should be done for 30 – 45 seconds per muscle.

Isolated strengthening exercises are used to facilitate the underactive muscles in the scapula. 

Concussions 

There are approximately 1.6 – 3.8 million sport and recreation related concussions that happen just in the US every year. 

Many of these will not even be recognized or followed up on after they occur. 

This is something that should definitely be looked into concerning sports, as the head is the most important part of the body. 

To protect the brain, the professional must control the head’s movement and positioning well. Specifically, the head and neck areas should be strengthened to resist these forces, even though that is not always enough.

Injury Rehabilitation

All rehab programs will aim to return the athlete to the competition stronger than when the injury happened. 

The focus for the professional will be on developing strength programs that complement the protocols that the licensed professionals put in place. 

Rehab Protocols 

The rehab from injury may be prescribed in three graded stages that we define by the athlete’s symptomology and recovery trajectory. 

Stage 1

• Acutely, all rehab to the traumatized area is managed at first and treated by the athletic trainer and sports medicine staff. 
• The sports performance professional here should focus on strengthening the muscles that were not traumatized around the injury using the iso-lateral and single limb exercises. 

Stage 2

• When athletes regain motion that is pain free in the area that was injured and is cleared by the doctors or professional they are seeing, they will then begin strength training for the area that was hurt. 
• Stage 2 training is therapeutic and progressive in its nature.
• Strength training will work to increase blood circulation to the area that was hurt and promote healing for that area while getting back to functional levels. 

Stage 3

• Stage 3 of rehab protocol focuses on returning the hurt area to baseline levels or greater levels than before the injury occurred. 

The whole process of rehab is done when these are met:

• There is a movement that is pain free.
• There is no noticeable sign of swelling.
• Full range of motion and mobility is re-established.
• The person has regained or even ideally exceeded the strength in the hurt area.
• The right level of metabolic fitness is reached for safe participation in the practice setting.